Perioperative Goal Directed Versus Conventional Fluid Therapy in Head and Neck Free Flap Surgery: A systematic review and meta-analysis

Head and neck free flap surgery is associated with considerable morbidity and mortality. Goal-directed fluid therapy (GDFT) has been increasingly adopted in perioperative care; however, its benefit over conventional fluid therapy (CFT) in this setting remains uncertain. This systematic review and meta-analysis assessed the effect of GDFT versus CFT on post-operative outcomes. A comprehensive search of PubMed, Web of Science, Cochrane Library, Dental/Oral Science, and Google Scholar identified randomised controlled trials published between 2010 and 2023. Three studies involving 262 patients (130 GDFT, 132 CFT) were included. Pooled analysis showed no significant difference in flap failure between groups, but CFT was associated with higher risk of flap at risk (risk ratio 4.44; 95% confidence interval [CI]: 1.35–14.57; P = 0.01), reoperation (risk ratio 2.62; 95% CI: 1.01–6.79; P = 0.05), and longer intensive care unit stay (mean difference 0.94 days; P < 0.001). GDFT may improve outcomes, but larger studies are needed to confirm these findings.